GASTROINTESTINAL MNEMONICS

Ulcerative colitis: definition of a severe attack A STATE:
Anemia less than 10g/dl
Stool frequency greater than 6 stools/day with blood
Temperature greater than 37.5
Albumin less than 30g/L
Tachycardia greater than 90bpm
ESR greater than 30mm/hr

Vomiting: extra GI differential VOMITING:
Vestibular disturbance/ Vagal (reflex pain)
Opiates
Migrane/ Metabolic (DKA, gastroparesis, hypercalcemia)
Infections
Toxicity (cytotoxic, digitalis toxicity)
Increased ICP, Ingested alcohol
Neurogenic, psychogenic
Gestation

Pancreatitis (acute): causes GET SMASHED:
Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimmune (PAN)
Scorpion stings
Hyperlipidemia/ Hypercalcemia
ERCP
Drugs (including azathioprine and diuretics)
· Note: 'Get Smashed' is slang in some countries for drinking, and ethanol is an important pancreatitis cause.

IBD: surgery indications "I CHOP":
Infection
Carcinoma
Haemorrhage
Obstruction
Perforation
· "Chop" convenient since surgery chops them open.

Hereditary Nonpolyposis Colorectal Cancer (HNPCC) cause is DNA mismatch repair DNA mismatch causes a bubble in the strand where the two nucleotides don't match.
This looks like the ensuing polyps that arise in the colon.

IBD: extraintestinal manifestations A PIE SAC:
Aphthous ulcers
Pyoderma gangrenosum
Iritis
Erythema nodosum
Sclerosing cholangitis
Arthritis
Clubbing of fingertips

Digestive disorders: pH level With vomiting both the pH and food come up.
With diarrhea both the pH and food go down.

H. Pylori treatment regimen (rough guidelines) "Please Make Tummy Better":
Proton pump inhibitor
Metronidazole
Tetracycline
Bismuth
· Alternatively: TOMB:
Tetracycline
Omeprazole
Metronidazole
Bismuth

Bilirubin: common causes for increased levels "HOT Liver":
Hemolysis
Obstruction
Tumor
Liver disease

Ulcerative colitis: complications "PAST Colitis":
Pyoderma gangrenosum
Ankylosing spondylitis
Sclerosing pericholangitis
Toxic megacolon
Colon carcinoma

Cholangitis features CHOLANGITITS:
Charcot's triad/ Conjugated bilirubin increase
Hepatic abscesses/ Hepatic (intra/extra) bile ducts/ HLA B8, DR3
Obstruction
Leukocytosis
Alkaline phosphatase increase
Neoplasms
Gallstones
Inflammatory bowel disease (ulcerative colitis)
Transaminase increase
Infection
Sclerosing

Charcot's triad (gallstones) "Charge a FEE":
Charcot's triad is:
Fever
Epigastric & RUQ pain
Emesis & nausea

Haemachromatosis complications "HaemoChromatosis Can Cause Deposits Anywhere":
Hypogonadism
Cancer (hepatocellular)
Cirrhosis
Cardiomyopathy
Diabetes mellitus
Arthropathy

Pancreatitis: criteria PANCREAS:
PaO2 below 8
Age >55
Neutrophils: WCC >15
Calcium below 2
Renal: Urea >16
Enzymes: LDH >600; AST >200
Albumin below 32
Sugar: Glucose >10 (unless diabetic patient)

Pancreatitis: Ranson criteria for pancreatitis: at admission "GA LAW" (GA is abbreviation for the U.S. state of Georgia):
Glucose >200
AST >250
LDH >350
Age >55 y.o.
WBC >16000

Pancreatitis: Ranson criteria for pancreatitis: initial 48 hours "C & HOBBS" (Calvin and Hobbes):
Calcium < 8
Hct drop > 10%
Oxygen < 60 mm
BUN > 5
Base deficit > 4
Sequestration of fluid > 6L

Pancreatitis: Ranson criteria for pancreatitis at admission LEGAL:
Leukocytes > 16.000
Enzyme AST > 250
Glucose > 200
Age > 55
LDH > 350

GIT symptoms BAD ANAL S#!T:
Bleeding
Abdominal pain
Dysphagia
Abdominal bloating
Nausea & vomiting
Anorexia/ Appetite changes
Lethargy
S#!ts (diarrhea)
Heartburn
Increased bilirubin (jaundice)
Temperature (fever)

Crohn's disease: morphology, symptoms CHRISTMAS:
Cobblestones
High temperature
Reduced lumen
Intestinal fistulae
Skip lesions
Transmural (all layers, may ulcerate)
Malabsorption
Abdominal pain
Submucosal fibrosis

Dysphagia: differential DISPHAGIA:
Disease of mouth and tonsils/ Diffuse oesophageal spasm/ Diabetes mellitus
Intrinsic lesion
Scleroderma
Pharyngeal disorders/ Palsy-bulbar-MND
Achalasia
Heart: eft atrium enlargement
Goitre/ myesthenia Gravis/ mediastinal Glands
Infections
American trypanosomiasis (chagas disease)

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Dry mouth: differential "DRI":
·2 of each:
Drugs/ Dehydration
Renal failure/ Radiotherapy
Immunological (Sjogren's)/ Intense emotions

Liver failure: decompensating chronic liver failure differential HEPATICUS:
Haemorrhage
Electrolyte disturbance
Protein load/ Paracetamol
Alcohol binge
Trauma
Infection
Constipation
Uraemia
Sedatives/ Shunt/ Surgery

Cirrhosis: causes of hepatic cirrhosis HEPATIC:
Hemochromatosis (primary)
Enzyme deficiency (alpha-1-anti-trypsin)
Post hepatic (infection + drug induced)
Alcoholic
Tyrosinosis
Indian childhood (galactosemia)
Cardiac/ Cholestatic (biliary)/ Cancer/ Copper (Wilson's)

Hepatic encephalopathy: precipitating factors HEPATICS:
Hemorrhage in GIT/ Hyperkalemia
Excess protein in diet
Paracentesis
Acidosis/ Anemia
Trauma
Infection
Colon surgery
Sedatives

Diabetic ketoacidosis: precipitating factors · 5 I's:
Infection
Ischaemia (cardiac, mesenteric)
Infarction
Ignorance (poor control)
Intoxication (alcohol)

Whipple's disease: clinical manifestations SHELDA:
Serositis
Hyperpigmentation of skin
Eating less (weight loss)
Lymphadenopathy
Diarrhea
Arthritis

Celiac sprue gluten sensitive enteropathy: gluten-containing grains BROW:
Barley
Rye
Oats
Wheat
· Flattened intestinal villi of celiac sprue are smooth, like an eyebrow.

Liver failure (chronic): signs found on the arms CLAPS:
Clubbing
Leukonychia
Asterixis
Palmar erythema
Scratch marks

Splenomegaly: causes CHIMP:
Cysts
Haematological ( eg CML, myelofibrosis)
Infective (eg viral (IM), bacterial)
Metabolic/ Misc (eg amyloid, Gauchers)
Portal hypertension